Provider Demographics
NPI:1487843710
Name:STA. ANA, DEMETRIO TAGULINAO JR (DDS)
Entity Type:Individual
Prefix:
First Name:DEMETRIO
Middle Name:TAGULINAO
Last Name:STA. ANA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3231
Mailing Address - Country:US
Mailing Address - Phone:559-277-0111
Mailing Address - Fax:559-277-0133
Practice Address - Street 1:3616 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3231
Practice Address - Country:US
Practice Address - Phone:559-277-0111
Practice Address - Fax:559-277-0133
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist